Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 0072.0128455 | VT |
NPI | 1215540117 |
---|---|
Provider Name | Katherine J Moody |
First Address | Fairfax, VT 05454-5534 |
Second Address | Saint Albans, VT 05478-6299 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2020 |
Last Update Date | 28/08/2020 |